Venous disease can lead to varicose veins, sores on your legs, or even more serious circulation problems like blood clots.

The specialists at the new FHN Vein Center at FHN Memorial Hospital can relieve your pain and provide long-term solutions to venous disease. Services offered include endovenous laser ablation and sclerotherapy, among others. All procedures are performed on an outpatient basis with typically rapid recovery. Non-cosmetic treatment options are covered by most commercial insurance carriers including Medicare.

What is venous disease?

Venous disease is the result of faulty valves in the veins and is called venous insufficiency. In a healthy vein, there are one-way valves that allow the blood to move toward the heart, but not away; arteries move blood away from the heart, moving nutrient-rich blood throughout your body, and veins return the nutrient-depleted blood to the heart to be re-infused with oxygen and other essential elements before being pumped back out to the body again by the arteries.

As such, arteries are muscular vessels that pump blood into the extremities. Veins are not as muscular and instead rely on the calf muscles in the leg to help them push blood up to the heart, against gravity. When the calf muscle contracts, it squeezes vein valves open so blood can flow upwards. The valves then close when the muscle relaxes to prevent blood from flowing back toward the feet. Dilation of the vein wall prevents the vein valves from sealing completely.

In a diseased vein, these valves do not work properly, allowing the blood to fall downward in between heartbeats. This back and forth motion of blood leads to an increased venous blood pressure, resulting in swelling and eventually inflammation of the tissues around the vein. Left untreated, this condition only worsens over time.

What do vein systems do?

Veins move nutrient-poor blood back to the heart to be rejuvenated. There are two vein systems that run parallel to each other.

The superficial venous system collects blood from the skin and upper layers of tissue. Sometimes you can see superficial veins on top of your foot or hand. Major superficial veins in the leg include the great saphenous vein and the small saphenous vein. Only a small amount of blood (10 percent) is actually returned toward the heart through the superficial venous system.

The great saphenous vein is a long, superficial vein that runs from the inside of the foot and ends near the groin, where it connects with the deep vein system. It's the most commonly treated vein for symptoms of venous disease.

The small saphenous vein is another superficial vein that runs from the outside of the foot up the back of the calf. It ends at the knee, where it connects with the deep vein system. This vein is the second most common vein to be treated for symptoms of venous disease.

Deep veins run underneath muscle tissue and are the workhorse of the venous system. In the leg, deep veins carry 90 percent of the blood out of the legs and back toward the heart. Major deep veins include the femoral vein and popliteal vein.

Blood is moved between these two types of veins through perforating veins, which act like bridges to ensure that enough blood is channeled into the deep veins rather than staying closer to the superficial veins on the body's surface.

One-way valves allow only inward blood flow from the superficial veins to the deep veins through perforating veins. Once the deep veins have circulated the blood throughout your lower body, the foot and calf muscles act to squeeze the blood out of those deep veins, and more one-way valves allow only upward blood flow toward the heart. It really is an amazing system, similar to locks and dams on rivers!

What about blood clots? Do they pose a risk?

We have all heard about the dangers of blood clots, ranging from heart attack and stroke to less critical issues like swelling in the legs and ankles. How do blood clots differ in severity?

Sometimes a clot occurs in the superficial venous system. This is referred to as superficial thrombophlebitis. It is rarely serious and the clot usually dissolves on its own, though it's always a good idea to check with your healthcare provider if you are having any symptoms such as warmth and tenderness  or redness and swelling  of a particular area, generally in your legs and feet.

Superficial thrombophlebitis symptoms tend to be localized. This means that they occur in the direct vicinity of the actual clot. You may even notice a raised, cord-like vein under the skin.

Deep vein trombosis (DVT) is a condition where a blood clot forms in the deep veins. While there are no known specific causes for DVT, factors that may put you at a greater risk are:

Being inactive for long periods of time, including prolonged bed rest

Major surgery (especially knee replacements)

Hereditary clotting disorders or a family history of blood clots

Older age

Certain medications (your doctor or pharmacist can alert you to any risks when prescribing medications for you)

If you have a deep vein thrombus (clot), it's considered a medical emergency and you should head straight to the emergency room. Symptoms of DVT are:

Swelling of the whole leg

Changes in skin color, including redness, bluish, or pale appearance

Pain in your leg that may start out as a cramping feeling

Warmth of the skin

If you experience any of these, get to the emergency room as quickly as possible.

What causes venous disease?

Heredity is the No. 1 risk factor for venous disease. If your parents had varicose veins, you have an 89 percent chance of developing them.

Next to heredity is gender. Women, especially those who have had multiple pregnancies, are three times more likely than men to develop venous disorders.

Age is also a risk factor. While older people are at a higher risk for venous disease, it can start as early as childhood.

Trauma from an accident or from a medical procedure that damages the vein may contribute to vein and circulation problems, and obesity can be a factor although not a primary risk. Professions that require long periods of sitting or standing also increase the risk for venous disease.

Treatment at the FHN Vein Center

There are two approaches to venous disease treatment. The first involves wearing compression hose that apply a graduated pressure on your legs; the second is outpatient surgical treatment.

Compression Socks and Hose

Compression garments for your legs are tightest at the ankle and decrease in pressure as they move up the leg. This prevents prevent blood from pooling in the legs and ankles by providing support to the veins and skin. Wearing compression hose can alleviate symptoms like aching, pain, and leg fatigue. They also reduce the recurrence of venous ulcers and speed the resolution of phlebitis and DVT (blood clots).

There are many different types of compression hose. Some cover your feet while others are footless, and they come in knee-high, thigh-high, and full-leg lengths or leotard styles in a variety of fabrics and colors, making them virtually indistinguishable from regular socks or tights/pantyhose. They also come in different grades that indicate the amount of pressure exerted by the hose at various points along your legs. We can let you know the right grade for your situation.

Compression hose work best in combination with regular exercise. Thirty minutes a day is ideal, but it's important to stay away from heavy lifting or other more strenuous activities, which can worsen venous disease. As mentioned earlier, your legs and feet function as pumps to help move blood through your veins and back to your heart so toned calf muscles, strengthened by walking and other lower-body exercise, will help provide more efficient blood flow.

Surgical Treatment on an Outpatient Basis

Over 40 million Americans suffer daily with painful, swollen legs as a result of venous disease. In the United States, 25 percent of women and 15 percent of men needlessly suffer from this condition. And although venous disease is five times more prevalent than peripheral arterial disease (PAD), a narrowing of the arteries similar to coronary artery disease (CAD), only 3 percent of those with venous disease have been treated.

At the FHN Vein Center, we offer several different types of procedures, all on an outpatient basis. Recovery time is typically quite fast  sometimes within just a few hours  and non-cosmetic treatments are usually covered by insurance, including Medicare.

Endovenous Laser Ablation

Endovenous laser ablation is the most common procedure, and is considered the "gold standard" in treatment of venous disease. This is a minimally invasive procedure that begins with the insertion of a catheter into an unhealthy vein through a small incision. Numbing solution is then injected around the vein. Next, the laser tip of the catheter heats the inside of the vein, causing the collagen in the vein wall to collapse and seal shut. The body then automatically begins to re-route blood to healthy, functional veins.

This procedure usually takes less than an hour. Patients walk in and walk out of the procedure and continue with their normal everyday activities. There is no downtime and the success rate is an impressive 99 percent.

Phlebectomy

A phlebectomy is an in-office procedure that involves the removal of bulging varicose veins. The veins that bulge out of the skin are considered secondary varicose veins because they're actually smaller branches of the great saphenous or small saphenous veins.

The great and small saphenous veins are the primary sources of venous insufficiency, so they must be treated first with endovenous laser ablation. Afterwards, the doctor can perform a limited phlebectomy to remove the twisted, lumpy veins through small incisions. This procedure takes less than half an hour, doesn't require stitches, and, like laser ablation, has no downtime.

Sclerotherapy

Spider veins are a result of dilated venous capillaries that fill with blood and become visible. These are not considered harmful and are usually treated for cosmetic reasons.

Sclerotherapy is the injection of a sclerosing solution, which works by damaging the cells lining the inside of the veins. This makes blood platelets attach themselves to the lining of the vein. Eventually, cellular debris and platelets clot the vein, causing it to collapse and fade. Over time, the collapsed vein is replaced with tissue free of spider veins.

Several treatments may be necessary depending on the severity of the spider veins. Full results can be expected within six months after treatment.

Sclerotherapy is considered a cosmetic outpatient procedure and is therefore generally not covered by insurance; We can work with you to arrange payment.

Need help? Finding the right providers for you and your family is an important step in ensuring your best health. If you need help finding a provider, please call us at 1-877-6000-FHN, 1-877-600-0346 ext 965.

Many of our specialty care offices require a referral from primary care for your initial visit, so if you're already an FHN patient, you may need to contact your primary care provider for more information. If you're new to FHN, or don't have a primary care provider, call the number above and you'll have a primary care appointment before you hang up the phone!* Thank you for choosing FHN!

*Restrictions or requirements of health insurance carriers may apply; eligibility will be confirmed during our conversation with you.